Share this e-Alert:

Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care
         

  

July 2016

  

CMS Proposes Additions to Medicare's Telehealth Services

  

 
 

  

     

  

 
 

For more information about this e-Alert, please contact:

  

Laura Little

404.253.6055

Email | Bio

  

Cybil G. Roehrenbeck

202.777.8931

Email | Bio

  

Sidney Welch

404.253.6047

Email | Bio

  

To learn more about our Health Care practice, to contact one of our Health Care attorneys, or for more Health Care Intelligence, click here.

  

  


Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care Polsinelli - Health Care View Polsinelli documents on JD Supra  

SUBSCRIBE

LinkedIn Twitter Facebook Polsinelli Podcast
   

On July 7, the Centers for Medicare and Medicaid Services (CMS) released the CY2017 Physician Fee Schedule Proposed Rulei, which, in addition to updating payment rates, proposes to expand marginally the list of telehealth services eligible for Medicare reimbursement. The proposed changes do not represent a marked change from CMS' historical policies regarding telehealth reimbursement. Rather, these changes hint at CMS' greater willingness to accommodate and encourage providers' adoption of such technologies to expand access to quality care for rural beneficiaries. Additionally, CMS suggests modifications to current policies on Place of Service (POS) coding and clarified current payment policies for telehealth services rendered in hospitals. Comments on the proposed rule are due on September. 6, 2016.

Medicare Telehealth Services List:

Starting in CY2017, CMS is proposing to add several services to the list of telehealth services eligible for Medicare reimbursement when provided in accordance with all pre-existing legal requirementsii, including:

  • ESRD Related Services
  • Advance Care Planning Services
  • Critical Care Consultations Furnished Via Telehealth
    [Expand list]

CMS considered, but rejected, requests to add the following CPT codes to the list of eligible telehealth services:

  • Observation Codes
  • Emergency Department E/M Services
  • Psychological Testing
  • Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services
    [Expand list]

Place of Service (POS) Code Suggestions

Although the POS workgroup establishes policies for POS code usage, CMS proposed various modifications to existing POS code policies for reporting telehealth services to allow for possible future POS workgroup decisions governing appropriate coding, which might occur before January 1, 2017. Specifically, CMS proposed to require practitioners furnishing telehealth services to report the POS code it would use if the services were furnished in-person (i.e., the patient location) so as to indicate that the services were provided via telehealth. On receipt of such claim, CMS also proposed to use the facility practice expense relative value units (PE RVUs) to reimburse for the telehealth services reported. Meanwhile, CMS suggested that POS Code usage for the originating site remain unchanged the originating site should continue to bill for the facility fee and continue to use the POS Code applicable to the patient's location (facility or non-facility) so as to receive the correct reimbursement rate (either facility PE RVU or non-facility PE RVU).

Policy Clarification: Hospital Telehealth Services

Finally, CMS proposed revisions to existing regulations to clarify that, when telehealth services are furnished in a hospital and the hospital is not being paid for such services, payments under the physician fee schedule should be made at the facility rate (facility PE RVUs). This policy is not new but rather a restatement of CMS' existing stance on appropriate billing in such scenarios.

To view or download the full PDF, click here.

For More Information

For questions regarding this information, please contact one of the authors, a member of Polsinelli’s Health Care practice, or your Polsinelli attorney.

  


  

i Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for Calendar Year (CY) 2017 (proposed July 6, 2016) available here.

ii See 42 U.S.C. § 1395m(m); See also 42 C.F.R. § 410.78.

iii See Section 1834(m)(4)(E) of the Social Security Act as defined by Section 1842(b)(18)(C) of the Social Security Act.

 
             

 

  

     

  

 
 

Atlanta  Boston  Chattanooga  Chicago  Dallas  Denver  Houston  Kansas City  Los Angeles  Nashville  New York
Overland Park  Phoenix  Raleigh  St. Joseph  St. Louis  San Francisco  Washington, D.C.  Wilmington
polsinelli.com

 
 

  

     

  

 
 

  

ABOUT POLSINELLI

real challenges. real answers.SM  
Polsinelli is an Am Law 100 firm with more than 800 attorneys in 19 offices, serving corporations, institutions, and entrepreneurs nationally. Ranked in the top five percent of law firms for client service*, the firm has risen more than 50 spots over the past five years in the Am Law 100 annual law firm ranking. Polsinelli attorneys provide practical legal counsel infused with business insight, and focus on health care, financial services, real estate, intellectual property, mid-market corporate, and business litigation. Polsinelli attorneys have depth of experience in 100 service areas and 70 industries. The firm can be found online at www.polsinelli.com. Polsinelli PC. In California, Polsinelli LLP.

* 2016 BTI Client Service A-Team Report

  

 
 

  

     

  

 
 

Polsinelli provides this material for informational purposes only. The material provided herein is general and is not intended to be legal advice. Polsinelli is very proud of the results we obtain for our clients, but you should know that past results do not guarantee future results; that every case is different and must be judged on its own merits; and that the choice of a lawyer is an important decision and should not be based solely upon advertisements.

Copyright © 2016 Polsinelli PC.

 
             
Connect with us on LinkedIn. Connection with us on Twitter. Connect with us on Facebook. Polsinelli Health Care Technology Health Care